Fillable Printable Application for Marriage License or Certificate - Hawaii

Application for Marriage License or Certificate - Hawaii

Your marriage record is vital.

Be sure the information you give is complete and accurate.

PLEASE PRINT – USE BLACK INK

MARRIAGE LICENSE APPLICATION

TO BE FILLED OUT BY COUPLE MAKING APPLICATION

(Please read instructions on reverse side of this form)

STATE OF HAWAI’I  DEPARTMENT OF HEALTH

OFFICE OF HEALTH STATUS MONITORING

LICENSE NO.

APPLICANT I

Zip Code

 Groom

 Bride

 Spouse

1a. FIRST NAME OF APPLICANT I b. MIDDLE NAME c. LAST NAME

1d. SOCIAL SECURITY NO.

2. DATE OF BIRTH (Month, Day, Year)

3. USUAL RESIDENCE: a. STREET ADDRESS

CITY

b. COUNTY

c. STATE OR FOREIGN COUNTRY

4. PLACE OF BIRTH: *City & State/Country

5. FATHER: a. FULL NAME – FIRST, MIDDLE, LAST

b. STATE OR FOREIGN COUNTRY OF BIRTH*

c. Living?* Yes, No,

Refused, or Unknown

6. MOTHER: a. FULL NAME – FIRST, MIDDLE, MAIDEN NAME

b. STATE OR FOREIGN COUNTRY OF BIRTH*

c. Living?* Yes, No,

Refused, or Unknown

APPLICANT II

Zip Code

 Groom

 Bride

 Spouse

7a. FIRST NAME OF APPLICANT II b. MIDDLE NAME c. LAST NAME

7d. SOCIAL SECURITY NO.

8. DATE OF BIRTH (Month, Day, Year)

9. USUAL RESIDENCE: a. STREET ADDRESS

CITY

b. COUNTY

c. STATE OR FOREIGN COUNTRY

10. PLACE OF BIRTH: *City & State/Country

11. FATHER: a. FULL NAME – FIRST, MIDDLE, LAST

b. STATE OR FOREIGN COUNTRY OF BIRTH*

c. Living?* Yes, No,

Refused, or Unknown

12. MOTHER: a. FULL NAME – FIRST, MIDDLE, MAIDEN NAME

b. STATE OR FOREIGN COUNTRY OF BIRTH*

c. Living?* Yes, No,

Refused, or Unknown

Blood relationship of Applicant I

to Applicant II:

In what county do you plan to be married?

(Honolulu, Hawai’i Maui,

or Kaua’i County)

When do you plan to be married?

Name of Marriage Performer (Commissioned by the State of Hawai’i)

FORWARDING ADDRESS:

(After Marriage)

DO YOU WANT YOUR NAMES  YES  NO

PRINTED OR POSTED ELECTRONICALLY IN THE NEWSPAPER?

E-MAIL ADDRESS:

HOME/CELL PHONE NUMBER:

WORK PHONE NUMBER:

CONFIDENTIAL INFORMATION – PLEASE COMPLETE

SUPPLEMENTARY

DATA

NO. OF THIS

MARRIAGE/OTHER

LEGAL UNION

CURRENTLY

IN CIVIL UNION OR

OTHER LEGALLY

RECOGNIZED

UNION WITH SAME

PARTNER?

IF PREVIOUSLY MARRIED OR IN OTHER LEGALLY RECOGNIZED

UNION, LAST MARRIAGE/OTHER LEGAL UNION ENDED.

RACE*

OCCUPATION*

EDUCATION* -

Specify Highest

Grade

Completed

SEX

FIRST, SECOND,

ETC. (SPECIFY)

BY DEATH, DIVORCE,

DISSOLUTION,

ANNULMENT OR

TERMINATION (specify)

DATE ENDED

PLACE ENDED

(COUNTY & STATE)

MONTH YEAR

APPLICANT I

21a.

21b.

22a.

22b.

22c.

23.

24.

25.

26.

APPLICANT II

27a.

27b.

28a.

28b.

28c.

29.

30.

31.

32.

FOR OFFICE USE ONLY

CERTIFICATION - SIGN BEFORE MARRIAGE AGENT

APPLICANT I:

SIGHTED:

NAME ? Yes No

DOB ? Yes No

AGE: Sex: M F

Previous Marriage(s)/Legal

Union(s):

APPLICANT II:

SIGHTED:

NAME ? Yes No

DOB ? Yes No

AGE: Sex: M F

Previous Marriage(s)/Legal

Union(s):

We, the undersigned, certify that the information given in this application is true and correct to be best of our knowledge and belief.

FULL SIGNATURE OF APPLICANT I

FULL SIGNATURE OF APPLICANT II

Sworn and subscribed to before me this day of , 20

MARRIAGE LICENSE AGENT JUDICIAL DISTRICT, STATE OF HAWAI’I

OHSM-1 ITEMS INDICATED WITH * ARE OPTIONAL, BUT DO NOT LEAVE THESE ITEMS BLANK; ENTER REFUSED INTENTIONAL FALSIFICATION IS A CRIME

TO BE FILLED OUT JOINTLY BY COUPLE MAKING APPLICATION

(Do not make separate applications for Applicant I and Applicant II.)

REQUIREMENTS FOR OBTAINING A MARRIAGE LICENSE

In applying for a marriage license, both applicants must appear in person before

a marriage license agent.

A marriage license is issued immediately after the application is made. After

being issued, the license expires within 30 days and it is valid statewide.

To marry, both applicants must be at least 15 years of age. Applicants who are

16 or 17 years of age must have the written consent of both parents, or of the legal

guardian, or other person in whose care and custody the minor has been placed, or of

the family court judge who has jurisdiction over the minor child. Applicants may marry

at age 15 years with the written consent of both parents or legal guardian and the

written approval of the judge of the family court. No one under 15 years of age may

marry.

Proof of age in the form of a certified copy of a birth certificate must be presented

to the marriage license agent by any applicant who is under 19 years of age. Proof of

age may be requested for those applicants over 18 in the form of an I.D. or driver’s

license.

A blood relationship between Applicant I and Applicant II must not be closer than

first cousins.

Blood tests are not required.

The fee for a license is $60.00 (plus $5.00 portal administration cost), payable at

the time of filing the application.

INSTRUCTIONS FOR FILLING OUT APPLICATION FORM

Please use black ink. Print information so that it can be read easily. If you

have a home or office telephone, give number in left margin. Do not sign the

application until the marriage license agent asks you to do so. It must be signed in

his or her presence.

Name of Applicant I and Applicant II. Enter the full first, middle, and last names.

Do not use abbreviations or initials.

Date of Birth. Enter the exact month, day and year. Enter the full name of the

month — January, February, March, etc.

Usual residence. Give street address, if any, and enter the name of the city or

town in full and the county. Enter zip code number in space provided in left

margin. If no street address, enter name of town or village. Mailing address may be

used but must be enclosed in parenthesis before the name of the town or village.

DO NOT USE MAILING ADDRESS ALONE.

Place of birth. For Applicant I and Applicant II, give city or town and state, or city

or town and foreign country.

Father and mother. Enter full first, middle, and last names without abbreviations

or initials. For mother, enter full maiden name. For place of birth, enter state or foreign

country only. After “Living?” state “yes” or “no,” or “unknown.”

Blood relationship of Applicant I to Applicant II. Generally, the entry here will be

“none.”

In what county do you plan to be married? Honolulu County, Hawai‘i

County, Maui County, or Kaua‘i County.

When do you plan to be married? Date of ceremony must be within 30 days

of application.

Name of marriage performer. Person who is to perform the marriage

ceremony.

Note: Hawai‘i state law requires that the person performing the marriage

ceremony must be licensed by the State of Hawai‘i, Department of Health;

otherwise, the marriage may be declared invalid (Sec. 572-1-8, HRS).

Forwarding address (After marriage). Enter mailing address where you would

like the certified copy of your marriage certificate to be sent.

Do you want your names published in the newspaper? Names printed on a

space available basis as a public service; no charge. (May not be available on all

islands).

Number of this marriage/other legal union. First, second, third, etc.

If previously married or in other legally recognized union. State how your last

marriage/other legal union ended, i.e., by death, divorce, dissolution, annulment or

termination. Then enter the date and place of death, divorce, dissolution, annulment

or termination.

Race. Use such terms as Japanese, Caucasian, Black, Hawaiian, etc. Using

the term Hawaiian may be advantageous, if appropriate.

Occupation. Give your usual occupation, such as: carpenter; bookkeeper;

student; sales clerk; auto mechanic; soldier–U.S. Army; sailor–U.S. Navy; or

officer–U.S. Army; officer–U.S. Navy; etc. (Give kind of work done during most of

working life, even if retired).

Education. Enter the number of the highest grade completed in “regular“

schooling in the space for elementary/secondary or college.

Note: Do not enter any other kind of schooling or training. Although beauty

and barber schools, business or trade schools and the like, are important, they are

not considered “regular” schools for the purpose of this item.

Confidential Information. Information on previous marriage, race, occupation

and education is confidential and will not be reproduced on certified copies of

your marriage certificate but used for statistical purposes only.

* Do not leave these items blank. Enter “refused.” rev 12/2013